Hospitalized children have high rates of polypharmacy exposure

Abstract

MedWire News: Results from a retrospective cohort study indicate that a substantial number of hospitalized children in the USA are exposed to polypharmacy.

Earlier findings have noted that many medications given to children do not have established efficacy and safety in this population and are often administered off-label. In addition, medication errors often occur in the hospital setting.

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Therefore, more information is needed about the types and number of agents given to hospitalized pediatric patients in order to give researchers a clear idea about real-world usage, to enable them to effectively construct studies about the impact of pediatric inpatient medications.

Chris Feudtner (The Children's Hospital of Philadelphia, Pennsylvania, USA) and colleagues reviewed medication use data from two large databases. Records from over 587,000 patients admitted to either general hospitals or children's hospitals in 2006 were analyzed; these data represent about 20% of all pediatric inpatient US hospitalizations that year.

The investigators categorized the records into 20 common medication categories and 15 common generic medication exposure methods. The number and percentage of patient hospitalizations exposed to all therapeutic agents was stratified by patient age and hospital type.

As reported in the Archives of Pediatric and Adolescent Medicine, on the first day of hospitalization, pediatric patients admitted to children's hospitals were exposed to a greater number of separate drugs/therapeutic agents than those admitted to general hospitals, with a large proportion of all groups receiving five or more agents. This was true for both infants and children aged 1 year or older.

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The longer the patient hospital stay, the more drugs/agents they were exposed to, note the researchers. Using an unadjusted model, the team estimated that patients in children's hospitals were exposed to 1.34 times more drugs/agents during their stay than patients in general hospitals. Exposure levels were higher for those with rarer conditions.

The most common generic drugs and therapeutic agents given to patients were intravenous fluids, analgesics (including narcotics), anesthetics, gastrointestinal drugs, anti-infective agents, and the agents usually given to infants as part of routine care.

Patients in children's hospitals were more likely to receive cardiovascular and antineoplastic medications.

Feudtner and colleagues conclude that there are three important takeaway messages from their findings, which may provide the basis for developing ways to improve patient care.

"First, ranking of drug and therapeutic agents based on the prevalence of hospitalized children's exposure can guide prioritization of further research. Second, the common exposure to polypharmacy among hospitalized children motivates investigation of combinations of drugs and therapeutic agents to which patients are exposed and studies to detect potentially adverse drug-drug interactions. Third, these databases offer the potential to conduct rigorous comparative effectiveness and safety studies, [as] their data are sufficiently detailed regarding the timing and patterns of medication exposures during the course of a hospitalization episode," concludes the team.